The objective of this proposal is to assess the effects of rural hospital closings on access to hospital care and outcomes of hospital care for those Medicare populations living in the geographic areas where the closings occurred. We will examine these changes in the market areas of hospitals that closed in 1986, 1987, and 1988. We will compare the experience of Medicare populations living in the rural areas where hospitals closed to the experience of similar Medicare populations living in rural areas where no hospital closures occurred. this will enable us to separate the effects of the hospital closures from general trends in treatment and technology which occurred over the same time period. We will examine changes in access and outcomes for the Medicare populations on measures of: 1) Access to care (admissions per 1000 Medicare population in service area); 2) Average length of stay of Medicare patients; 3) Health status (severity of illness) at time of admission; 4) Complication rates for Medicare patients; 5) Risk adjusted rates of readmission within 30 days of discharge; 6) Risk-adjusted mortality rates; 7) Discharge destinations for Medicare patients; 8) Average cost per admission; 9) Average cost of hospital care per year for hospitalized patients. This proposal offers a unique approach to studying these issues, using a new combination of analytic methods; Small-Area Analysis, in combination with measures of changes in risk-adjusted mortality, complication, and readmission rates. We will use existing data sources to conduct the analysis, since these data will allow us to gain a historical perspective in evaluating the changes that have occurred in hospital care.